美国妇产科医师学会“盆腔器官脱垂临床实践指南(2017版)”解读

正盆腔器官脱垂(pelvic organ prolapse,POP)是中老年女性中较普遍的良性疾病。许多患者会出现阴道膨出、尿失禁或排尿功能障碍、排便功能障碍和性生活障碍等临床症状,严重影响生活质量。据不完全统计,美国有超过13%的女性需要手术治疗POP,尽管POP也可以发生在年轻的患者中,但是其发病的年龄峰值还是在70～79岁之     

钼靶和MR诊断乳腺纯黏液腺癌

目的 探讨乳腺纯黏液腺癌钼靶及MRI影像学特征。方法 回顾性分析25例经手术病理证实为乳腺纯黏液腺癌患者的资料,11例接受MR检查,17例接受钼靶检查,其中3例同时接受MR及钼靶检查。结果 17例纯黏液腺癌钼靶表现包括：肿块10例,肿块伴微钙化3例,不对称影1例,不对称影伴微钙化2例,钼靶阴性1例。13例以肿块（或伴钙化）为表现的病灶中,6例为高密度,7例为等密度。11例纯黏液腺癌MRI表现包括：9例病灶呈肿块样强化,其中8例呈边缘环形强化,1例早期不均匀强化、晚期均匀强化;2例呈非肿块样强化,均呈段样分布;所有病灶动态增强曲线均为流入型,TIRM及T2-FS序列均为高信号或等高混杂信号。结论 乳腺纯黏液腺癌钼靶多表现为等密度肿块,MRI长TE序列高信号及动态增强序列边缘环形强化较具特征性。     

“商环”包皮环切术与传统包皮环切术疗效比较

目的探讨“商环”包皮环切术与传统包皮环切术的临床疗效。方法包皮环切术493例按治疗方法分为：商环组220例,传统手术组273例。比较二组手术时间、出血量、伤口疼痛、并发症（伤口水肿、裂开、感染、出血）,愈合时间,患者满意率,总治疗费用等相关指标。结果所有病人手术均顺利,并获得满意效果。二组各观察指标比较,手术时间、出血量、伤口疼痛、并发症（伤口水肿,裂开）、伤口愈合时间、手术费用等均存在统计学意义（P〈0．05）,术后并发症（伤口感染,出血）、患者满意率无明显统计学意义。结论两种手术方式均能获得满意疗效,相比之下“商环”包皮环切具有手术时间短,术中出血少、术后疼痛轻、切缘整齐等优势,但其术后愈合时间较长,术后伤口水肿、裂开发生率及总费用相对较高。因此,临床选择何种手术方式应权衡利弊,充分考虑患者及家属意愿。     

原发性十二指肠球部印戒细胞癌1例

病例：患者 男,82岁。因“腹痛、腹泻2年,加重3月余”于2012年10月17日拟“腹痛待查”入院。患者2年前无明显诱因下出现上腹部绞痛,伴腹泻,     

不锈钢麻花牵引圈的制作及在管腔器械清洗质量检查中的应用

目的制作不锈钢麻花牵引圈并探讨其在管腔器械清洗质量检查中的应用效果。方法将制作的不锈钢麻花牵引圈用于管腔器械清洗质量的检查,通过与目测+光源放大镜法、探条纱布法、ATP生物荧光法做比较,评价其在管腔器械清洗质量检查中的效果。结果 A类空腔器械清洗质量检查中,麻花牵引圈法、目测+放大镜法和ATP生物荧光法的清洗质量检查合格率差别有统计学意义(P<0.010),两两比较,目测+放大镜法合格率最高,与其他2组的检查合格率差异具有统计学意义(P<0.017),麻花牵引圈法与ATP生物荧光法的检查合格率差异无统计学意义(P>0.017)。B类空腔器械清洗质量检查中,4种清洗质量检查方法合格率差异具有统计学意义(P<0.010),两两比较,目测+放大镜法合格率最高,与其他3组的检查合格率差异具有统计学意义(P<0.008)。麻花牵引圈法、探条纱布法和ATP生物荧光法的检查合格率差异无统计学意义(P>0.008)。结论不锈钢麻花牵引圈在管腔器械清洗质量检查中,能发现目测+放大镜法无法检出的不合格器械,其检测效果与探条纱布法、ATP生物荧光法相当,比ATP生物荧光法...     

Power Analysis for the NOEC: What is the Probability of Detecting Small Toxic Effects on Three Different Species using the Appropriate Standardized Test Protocols?

The power to detect small toxic effects with ecotoxicity tests is investigated on the basis of ring tests for the protocols of three standardized reproduction tests. The test species are Daphnia magna, Eisenia fetida and Folsomia candida, respectively.The coefficient of variance for reproduction in the controls of these tests is about 14.4% for D. magna, and 19% for both E. fetida and F. candida. Given the standardized test protocols this implies that a reduction inhibition of 20% will be observed in 80% of the D. magna tests and in only 18% of the tests with either E. fetida or F. candida. Comparing 5 different concentrations with one control, 12 replicas are needed per concentration and 27 in the control for D. magna, and 21 and 47, respectively, for both E. fetida and F. candida to observe an effect of 20% in at least 95% of the experiments.The power analysis is based on a one-sided Dunnett test. This test assumes normal distributed data with equal variance at all treatments. These assumptions are checked for the D. magna test using ring test data. The distribution of these data does not deviate substantially from normal. For small toxic effects, no significant correlation between mean and variance of reproduction was observed.     

Auditory-responsive units in the midbrain vocal nuclei in the ring dove (Streptopelia risoria)

The avian midbrain vocal control nucleus n. intercollicularis (ICo), receives inputs from midbrain auditory nucleus and from a subdivision of auditory thalamus, suggesting a possibility of auditory response units in the ICo. Using single-unit recordings, we explored auditory response units throughout the dorsomedial midbrain of female ring doves under deep general anesthesia (acute preparation). We found exclusively in the ICo, units that responded preferentially to taped courtship coos of conspecifics (male or female coos) and units that responded to specific frequencies present in coos. Units in the midbrain auditory nucleus also responded to these auditory stimulation in a tonotopic fashion, and were responsive to tone burst as well. The results, along with data from other experiments, suggest that species-specific sound responsive units within the ICo may mediate acoustically facilitated female coos and endocrine responses of the ring dove.     

Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse?

The aim of the study was to evaluate the use of a vaginal pessary in the detection of genuine stress incontinence (GSI) in women with urogenital prolapse undergoing urodynamic investigation. Continent women with urogenital prolapse, with or without associated urinary symptoms, were studied. All underwent video-cystourethrography using a standarized protocol. None had evidence of incontinence on provocative testing in the upright position. A well-fitting vaginal ring pessary was inserted to reduce the prolapse and mimic a vaginal repair. The provocative tests were then repeated while the bladder was screened. Seventy women with a mean age 59.0 years (range 34–83) were recruited over a 21-month period: 15 women complained of prolapse alone and 55 had concurrent urinary symptoms; 19 women (27%) developed GSI only following the insertion of a vaginal pessary. The women who became incontinent were significantly older (mean age 63.9 years) than those who remained continent (mean age 56.8 years) (P<0.020). The use of a vaginal pessary increases the detection rate of GSI in continent women with urogenital prolapse undergoing videocystourethrography. These findings are important becasuse women with prolapse and coexisting incontinence should be offered a continence procedure rather than a simple vaginal repair.Editorial Comment: All patients with significant uterovaginal prolapse require preoperative evaluation to rule out the presence of potential stress incontinence. The simplest and best way to perform this preoperatively has yet to be determined, although several methods have been described. These include a cough stress test or cough urethral profile performed with a full bladder with the prolapse reduced with a Sims' speculum, a pessary or vaginal packing. A pad test with the prolapse reduced in a similar fashion has also been used clinically to identify patients at risk for postoperactive potential stress incontinence following correction of pelvic prolapse. The authors present their experience using a ring pessary to reduce the prolapse during videourodynamic evaluation of lower urinary tract function, finding this technique to be effective in identifying patients who leak only with the pessary in place, and therefore, require an incontinence procedure. The pickup rate for this cohort of patients is similar to previous studies using alternative methods of detection. Perhaps the only question yet to be answered is the percentage of patients with negative testing preoperatively, yet who develop urinary incontinence immediately following surgical correction of pelvic relaxation. Only this determination will truly assess the clinical utility of the preoperative methods used to identify potential stress incontinence.     

Is the androgen-dependent increase in preoptic estradiol-17β formation due to aromatase induction?

Aromatization of testosterone in the preoptic area of the male ring dove is required for the expression of specific estrogen-sensitive sexual behavior. Estradiol metabolism and/or binding of the aromaization product(s) to the preoptic estrogen receptors (ER) could interfere with the apparent increase in estradiol formation that occurs after androgen administration to castrated male. Therefore, we have re-examined the induction mechanism using a direct in vitro assay of aromatase activity. Since levels of aromatase activity and enzyme kinetics were similar irrespective of the assay used, we can conclude that increased estradiol formation after androgen stimulation is mainly due to enzyme induction and that estrogen binding and/or metabolism do not interfere significantly with the induction process.